Linda Jones Herbert

Text Message Interventions for Children and Adolescents with Type 1 Diabetes: A Systematic Review

Daily management challenges and declines in glycemic control are evident among youth with type 1 diabetes (T1D) as responsibility for care transitions from parent to youth. Many behavioral interventions developed for youth and their caregivers have demonstrated a small yet significant impact, and one method to potentially augment or increase their potency may be the use of mobile health strategies such as text messages. The primary aim of this systematic review was to evaluate the current literature regarding interventions incorporating text message-based interventions for youth with T1D. Feasibility was demonstrated across all text message programs, but participant satisfaction and glycated hemoglobin results were mixed. Retention rates varied, and technical difficulties were reported in several studies. Current evidence suggests that text message-based interventions that include text messages are feasible and enjoyable, but yet their clinical significance for long-term daily T1D management behaviors and glycemic control is unclear. Researchers are recommended to carefully consider the format, frequency, and timing of text message interventions and to fully test software before implementation. Future research needs include utilization of experimental designs such as randomized controlled trials, SMART design trials, and stepped wedge design trials to clarify specific medical and psychosocial outcomes, the role of caregivers/peers and incentives, and utility in clinical settings.

Sleep Behaviors and Parent Functioning in Young Children With Type 1 Diabetes

This study evaluates sleep characteristics among young children with type 1 diabetes and associations with parent sleep and emotional functioning and diabetes care. Study participants included 24 parents of young children with type 1 diabetes (ages 2–5) enrolled in a pilot study of a randomized-controlled trial. Child sleep characteristics were within normal limits. However, increased child bedtime resistance and behavioral insomnia were related to greater parent stress, anxiety, and depression and use of an intensive insulin regimen. Type 1 diabetes management may impact child and parent sleep as well as parent emotional functioning. Implications for practice are presented.

Mealtime behavior and diabetes-specific parent functioning in young children with type 1 diabetes.

OBJECTIVE Management of meals and mealtime behavior is often challenging for parents of young children with Type 1 diabetes. Parent functioning related to diabetes care may directly affect mealtime behaviors and glycemic control. This study evaluated associations among diabetes-specific parent functioning, parent and child mealtime behaviors, and glycemic control. METHOD Parents of young children with Type 1 diabetes (n = 134) completed self-report measures assessing diabetes-specific functioning (hypoglycemia fear, diabetes self-efficacy, diabetes-related quality of life) and child and parent mealtime behaviors. Hemoglobin A1c and percentage of blood glucose values out of range (<70 mg/dL or >200 mg/dL) over a 30-day period were abstracted from medical charts as indicators of glycemic control. Structural equation modeling was utilized to evaluate predictors and related outcomes of child and parent mealtime behavior. RESULTS The proposed model fit the data very well. More frequent problematic child mealtime behaviors were associated with poorer glycemic control; however, more frequent problematic parent mealtime behaviors were marginally associated with better glycemic control. Poorer diabetes-specific parent functioning was associated with more frequent problematic child and parent mealtime behaviors. CONCLUSIONS Problematic child mealtime behaviors, such as disruptive behavior, present a significant risk for poorer glycemic control. Parents may engage in ineffective mealtime management strategies in an effort to meet glycemic recommendations and avoid hyperglycemia and hypoglycemia. Future research will help to determine whether parents may benefit from specific, developmentally appropriate behavioral strategies to manage meals and snacks and promote optimal diabetes management.

Feasibility of the SMART Project: A Text Message Program for Adolescents With Type 1 Diabetes

This study investigated response rates to the Self-Management and Research Technology Project, a 6-week text message program for adolescents with type 1 diabetes designed to provide diabetes self-management reminders and education. The rate of response to texts was high, with 78% of texts responded to during the 6-week period. Girls and participants who self-reported sending a large number of personal daily texts had higher response rates; other demographic and medical variables were unrelated to text response rates. Inclusion of mobile health technologies such as text messages in clinical care may be a unique, relevant method of intervention for youths with type 1 diabetes, regardless of age, socioeconomic status, or glycemic control.

Using Qualitative Methods to Evaluate a Family Behavioral Intervention for Type 1 Diabetes

INTRODUCTION The objectives of this study were to qualitatively evaluate a dyadic adolescent-parent type 1 diabetes (T1D) program developed to prevent deterioration in diabetes care among adolescents with T1D and provide recommendations for program refinement. METHOD Thirteen adolescent-parent dyads who participated in the larger randomized controlled trial, the TeamWork Project, were interviewed regarding their perceptions of their participation in the program and current T1D challenges. Interviews were transcribed and coded to establish broad themes. RESULTS Adolescents and parents thought the TeamWork Project sessions were helpful and taught them new information. Five themes catalog findings from the qualitative interviews: TeamWork content, TeamWork structure, transition of responsibility, current and future challenges, and future intervention considerations. DISCUSSION Addressing T1D challenges as a parent-adolescent dyad via a behavioral clinic program is helpful to families during adolescence. Findings highlight the utility of qualitative evaluation to tailor interventions for the unique challenges related to pediatric chronic illness.

Mealtime behavior among parents and their young children with food allergy

BACKGROUND Food allergies are increasingly prevalent in the pediatric population. Balancing allergen avoidance with the promotion of healthy eating behaviors can be challenging for families. OBJECTIVE To characterize mealtime behaviors among parents of young children with food allergy. METHODS Seventy-four parents of young children with food allergies (≤7 years of age) completed measures of mealtime behavior, perceptions of food allergy risk and severity, pediatric parenting stress, and food allergy-related quality of life. Mealtime behavior reports were compared with published data regarding typically developing children, young children with type 1 diabetes, and children with diagnosed feeding disorders (with or without related medical factors). RESULTS Parents of young children with food allergies reported frequent mealtime concerns. Specifically, they reported significantly more mealtime behavioral concerns than typically developing peers, comparable mealtime behavioral concerns to young children with type 1 diabetes, and significantly fewer mealtime behavioral concerns than children with diagnosed feeding disorders. Parental mealtime concerns were positively correlated with other parent perceptions of food allergy, such as risk of allergen exposure, illness-related parenting stress, and food allergy-related quality of life. CONCLUSION Young children with food allergy and their parents are more likely to exhibit mealtime behavioral concerns than typically developing peers and their parents. Future research should investigate the effect of food allergies and maladaptive mealtime behaviors on childrens nutrition to provide clinical guidelines for parents who may benefit from psychosocial and/or nutritional support.

A pilot test of the Self-Management and Research Technology project: A text message-based diabetes self-management program for adolescents.

The aims of this study are to: (1) examine the preliminary utility of the Self-Management and Research Technology (SMART) pilot project, (2) identify which adolescents were most likely to benefit from participation, and (3) examine interview feedback to inform future program iterations. Twenty-three adolescents (M age = 15.13 years) were enrolled in the six-week text message pilot program consisting of daily interactive blood glucose (BG) prompts and type 1 diabetes-related educational text messages. Medical charts were reviewed for hemoglobin A1c and to corroborate medical record and demographic data. Glucometer data were downloaded to calculate an average monthly BG level and daily BG monitoring frequency. No statistically significant improvements were observed pre-intervention to post-intervention in glycemic outcomes. Participants with a high text message response rate were more likely to demonstrate improvement in average monthly BG levels and daily BG monitoring frequency than those with a low text message response rate. Participants reported satisfaction with the text message program. The text message-based SMART pilot project demonstrated preliminary efficacy for a targeted subset of adolescents who were engaged with the program. Continued research with a larger sample and longer trial duration is warranted to evaluate the potential utility of text message-based interventions.

Food Allergy: Psychosocial Impact and Public Policy Implications

Given its increasing prevalence and potential severity, food allergy not only negatively impacts the health and quality of life of affected individuals but also carries a significant economic burden. To address these problems, a community approach including efforts to increase awareness of food allergy among the general public and the implementation of appropriate public policies to keep affected individuals safe is required. This chapter reviews the general publics knowledge and perceptions of food allergy, the diseases psychosocial impact on affected individuals, and the current state and future directions of food allergy public policy.